Dental Quarterly Data Sharing
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Quarterly Reporting Form

FOURTH QUARTER | 10/1/18 - 12/31/18

Please complete the data form below.  If you are unable to answer a question you can leave the space blank and submit the form.  All fields with a red asterisk are required.





 Dental Blood Pressure Screening


Question #1


Are you providing Blood Pressure screenings with a documented procedure?

Question # 2 


How many dental operatories within your organization have a blood pressure monitor?

Question # 3 


Total Number of dental visits during the reporting period (age 18 and up).

Question # 4


Total number of Unique Patients who have received a blood pressure screening during the reporting period.

Question # 5 


Total number of blood pressure screenings performed during the reporting period.

UDS Measure- Dental Sealants
 Dental Treatment Plan 

 Dental No Shows

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